Successful selective arterial embolization in a patient with iliacus muscle hematoma and femoral neuropathy: A case report.

RATIONALE

Hematoma of the iliacus muscle is a rare but acknowledged complication associated with anticoagulant therapy. This condition may lead to nerve dysfunction due to compression, particularly affecting the femoral nerve. While there is no established guideline for its management, there has been a consensus favoring surgical intervention in cases of large hematoma with worsening neurological deficits.

PATIENT CONCERNS

A 67-year-old female presented to emergency room with acute groin pain, numbness in her right leg, and motor weakness following strenuous squat exercises. The patient had been prescribed warfarin for valvular atrial fibrillation. Laboratory tests revealed anemia and prolonged prothrombin time. Abdominal computed tomography revealed contrast leakage within the iliacus muscle. Subsequent electromyography and nerve conduction studies indicated findings suggestive of femoral neuropathy.

DIAGNOSIS

The patient was diagnosed with an actively bleeding iliacus muscle hematoma with femoral neuropathy.

INTERVENTION

Angiography of the right internal iliac artery identified contrast extravasation at the branch of the iliolumbar artery. Selective embolization of the iliolumbar artery branch was performed.

OUTCOMES

Following embolization, no further decline in hemoglobin level was observed. With discontinuation of anticoagulants and conservative management, the patient's sensory function in the right leg recovered, and the motor grade for knee extension improved from 1 to 4 within 3 weeks.

LESSONS

Even in the case of large iliacus hematoma with femoral neuropathy, conservative management without surgery can be a viable option if bleeding is well controlled with intervention.